终末期肾病患者死亡的相关因素研究

摘要

Objective To observe the causes of death in patients with end -stage renal disease (ESRD),and explore the major risk factors for death.Methods 1 36 cases with ESRD,from March 201 2 to March 201 3,admitted to our Department of Nephrology were se-lected for this study.Clinical data and biochemical results were collected accordingly.Survival rate was calculated by Kaplan -Meier Methods,and risk factors related to death were analysed by Cox regression analysis.Results Among 1 36 patients,37 patients died dur-ing the follow -up period:1 4 (37.84%)died of cardiovascular disease,8 (21 .62%)of septic shock,7 (1 8.92%) -of cerebrovas-cular disease,5 (1 3.51 %)of cancer,and 3 (8.1 1 %)of other causes.The Kaplan -Meier method results showed that 1 year survival rate and 2 -year survival rate of ESRD patients were 88.24%,and 72.79%,respectively.Age,the proportion of diabetic nephropathy and high -sensitivity C -reactive protein levels of death group were significantly higher than the survival group (P <0.05),while the urea clearance index,hemoglobin,albumin and high -density lipoprotein were significantly lower than the survival group (P <0.05 ). Cox regression analysis showed that age ≥65 years,low urea clearance index,low albumin and high levels of high -sensitivity C -reac-tive protein were risk factors for death in patients with ESRD.Conclusions Cardiovascular,cerebrovascular diseases and infection tox-ic shock are the main reasons for death in patients with end -stage renal disease.Older age,inadequate dialysis,malnutrition and high levels of high -sensitivity C -reactive protein are major risk factors related to death in ESRD patients.%目的：观察终末期肾病患者死亡原因，并探讨其死亡的主要危险因素。方法选取2012年3月—2013年3月于该院肾内科进行治疗且符合条件的136例终末期肾病患者为研究对象，收集患者的一般临床资料及生化指标检查结果。采用 Kaplan－Meier 方法对患者的生存率进行计算，使用 Cox 多因素回归分析影响患者死亡的危险因素。结果136例患者中，37例患者死亡，其中14例（37．84％）患者死于心血管疾病，8例（21．62％）死于感染中毒性休克，7例（18．92％）患者死于脑血管疾病，5例（13．51％）死于恶性肿瘤，3例（8．1 1％）患者死于其他原因。采用 Kaplan －Meier 法计算生存率结果显示：终末期肾病患者的1年生存率为88．24％，2年生存率为72．79％。死亡组患者的年龄、糖尿病肾病比例及高敏 C 反应蛋白水平显著高于存活组（P ＜0．05）；而其尿素清除指数、血红蛋白、白蛋白及高密度脂蛋白显著低于存活组（P ＜0．05）。Cox 多因素回归分析结果显示：年龄≥65岁、尿素清除指数较低、低白蛋白及高水平高敏 C 反应蛋白是终末期肾病患者死亡的危险因素。结论心脑血管疾病及感染中毒休克是终末期肾病患者死亡的主要原因，年龄较大、透析不充分、营养不良及高水平高敏 C 反应蛋白是患者死亡的主要危险因素。